November 2025 – The White House’s newly announced agreements with Novo Nordisk and Eli Lilly promise to lower the prices of popular GLP-1 medications such as Wegovy® (semaglutide) and Zepbound® (tirzepatide).

This is a victory for Americans who pay much higher prices for the same drug that people in other countries, struggling with obesity, diabetes, and cardiometabolic disease, pay. But beneath the headlines, the implications for employers and PBMs—who currently shoulder the bulk of GLP-1 costs—are far more complex.

🏥 A Step Forward for Medicare and Medicaid Beneficiaries

If finalized, this policy marks a turning point: Medicare and Medicaid beneficiaries could soon gain access to GLP-1s for obesity treatment, not just diabetes or cardiovascular risk reduction.

That’s a big deal. Until now, Medicare’s position had been clear—these drugs were not covered for weight loss. The expansion acknowledges obesity as a medical condition that warrants clinical treatment, rather than a lifestyle choice. This is real progress for public programs. It signals that our health system is starting to treat obesity as a root cause of disease, not just a symptom.”

💊 Direct-to-Consumer Pricing: Anything new ???

The White House announcement highlighted new direct-to-consumer (DTC) prices—around $350 per month for Wegovy and $300–$450 per month for Zepbound, depending on dose and channel.

While this grabbed headlines, the reality is that these prices are not entirely new. They largely reflect existing manufacturer self-pay programs already in the market:

In other words, the “new” DTC pricing appears aligned with existing manufacturer programs, rather than a dramatic market reset. The open questions:

• Does the lower pricing also apply to maintenance doses, where costs are typically highest?

• Will these rates apply to insured members, or only to cash-pay channels?

• How long will manufacturers be able to sustain these price points as demand continues to rise?

🧾 For Employers and PBMs: No Automatic Change, But Significant Leverage

For employers, this announcement does not automatically lower GLP-1 costs—PBM contracts remain as written.

However, it introduces a powerful benchmark for negotiation. If a consumer can buy Wegovy or Zepbound for $350 directly from the manufacturer, employers are right to ask:

“Why should our health plan pay more than an individual paying cash?”

This transparency sets the stage for employers to push for:

• Mid-cycle GLP-1 repricing or rebate true-ups

• Most-favored-net clauses guaranteeing parity with manufacturer DTC pricing

• Dose-specific caps to prevent runaway spend as members titrate upward

Even without an immediate financial impact, this public price signal changes the tone of employer-PBM negotiations heading into 2026.

⚙️ How Digbi Health Bridges Access, Outcomes, and Cost

While pricing grabs headlines, real value comes from how these drugs are prescribed, supported, and managed.

At Digbi Health, our Obesity Telehealth Clinic combines prescription access with precision lifestyle and clinical care. We help members—whether on employer plans, Medicare, or self-pay—get maximum results at minimal cost and dose.

Digbi’s clinical model includes:

• Virtual prescribing and medical support across all 50 states

• Food-as-Medicine and lifestyle care to reduce GI side effects and improve tolerability

• Continuous glucose monitoring (CGM) and data-driven dose optimization

• Genetic and microbiome insights to identify likely responders and personalize off-ramp plans.

By integrating Food-as-Medicine, gut microbiome science, and clinical coaching, Digbi helps members lose more weight, regain less, and reduce the total cost of care—whether they use a GLP-1 or not.

📊 The Bottom Line

The White House announcement represents a significant step toward expanding access and redefining affordability for GLP-1 drugs.

• For Medicare and Medicaid, it’s a long-overdue recognition of obesity as a treatable condition.

• For consumers, it could offer modest short-term savings—though actual benefits will depend on dosing and duration.

• For employers, it creates negotiating power, not automatic price relief.

The next chapter will depend on how plans, PBMs, and providers adapt. As prices evolve, employers must balance access with sustainability, ensuring these therapies deliver measurable health returns—not just higher utilization.